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Strategies to Reduce Sodium Intake in the United States
overreport their young children’s intake and be unable to estimate amounts accurately (Basch et al., 1990; Briefel et al., 1997; Devaney et al., 2004). Twenty-four hour recalls are also labor intensive to collect, and at least two non-consecutive days of data are needed to estimate usual intake.
Over the years, improvements in methodologies have been made as part of the National Nutrition Monitoring and Related Research Program (Woteki, 2003), and the quality and validity of data from 24-hour recalls have been improved. Efforts have focused on training dietary interviewers to use standardized probes to elicit complete and accurate reports of intake, using appropriate measurement aids to help respondents report amounts, and developing statistical adjustments to allow better estimation of usual intake (Dwyer et al., 2003). Nonetheless, the intake estimates for sodium derived from NHANES are likely to underestimate the population’s true total intake. However, despite the inherent measurement errors in dietary data collection and the underestimation of true total intake of sodium by the population, these measures provide useful and relevant information.
CURRENT SODIUM INTAKE OF THE U.S. POPULATION
For the purposes of this study, intake data from the NHANES covering 2003–2006 (i.e., combination of the 2003–2004 and 2005–2006 surveys) were used and designated as “current.” For analyses related to quantitative sodium intake, estimates are provided as usual intake (see Appendix E); analyses related to food categories as well as non-food contributions to the diet are reported as 1-day means, as is sodium intake from earlier NHANES.
As shown in Table 5-1, sources of dietary sodium include foods, salt added at the table, tap water, and dietary supplements. The sodium content of foods reflects salt added in cooking and food preparation. Methodologies for estimating table salt, tap water, and dietary supplements are described in Appendix E. Information on the contribution from medications was not available for the committee’s analysis. Drugs including anti-inflammatories, antacids, and laxatives can contribute to sodium intake.6 For example, sodium bicarbonate is often used to alleviate heartburn and acid indigestion.7,8 Although individuals with certain health conditions and their physicians may need to be concerned about the sodium content of some